Mandatory medical insurance for employees post lockdown-Good for families

Mandatory medical insurance for employees post lockdown-Good for families

There is no denial that penetration of health insurance has to increase so that large number of persons who are not part of:
-Group Corporate health insurance (at present voluntary) through insurance companies 
-CGHS
-ESIC
-State Government Health Scheme
-Defence forces Health Scheme
-Railway Health Scheme
-Ayushman

The fact is that this number is very large as they are working for micro units, unorganized sector, are self employed or are what we call daily wage workers.

Under order No. 40-3/2020-DM-I (A) The ministry of home affairs government of India has made it mandatory for all employers, who resume functioning post COVID-19 lockdown in the country, to provide medical insurance to their employees.

As per clause 5 of Annexure – II of the revised guidelines and standard operating procedure for social distancing for offices, workplaces, factories and establishments, medical insurance for the workers is to be made mandatory.

We understand that as a follow up action to this notification of  the government of India, the Insurance Regulatory and Development Authority of India (IRDAI) has asked all general and standalone health insurers to offer comprehensive health insurance policies either to individuals or groups in order to enable the listed organizations/employers/establishments comply with the government of India directives.

Ms. TL Alamelu IRDAI member (non-life) said, “The insurers are advised to devise comprehensive health insurance products with simple wordings, conditions and at affordable cost to be offered to the stated organizations”.

“The above referred organizations should be able to continue the medical insurance policy offered by insurers not only for the present situation but for all time,” said Ms Alamelu.

We see this is a great opportunity to increase the penetration of Health Insurance in the country.

ESIC is also covered under Consumers Protection Act

The first question arise after reading this news item is tht ESIC use the word Insurance then why it is not covered under IRDA.
DNA has covered a news item according to which
''Consumer courts have been given additional role by the government and the judiciary under the Consumer Protection Act (CPA), 1986. In a recent order of the Supreme Court of India, Employees State Insurance hospitals have also been included in the ambit of justice given by Consumer Courts. This was the order in the case of Kishore Lal vs chairman, Employees State Insurance Corporation (ESIC). Lal, a workman covered under ESIC, took his wife to an ESIC hospital for complications arising out of diabetes. She was admitted in hospital, but her condition deteriorated prompting Lal to transfer her to a private hospital. There it was known that both the diagnosis and treatment given to her was incorrect. Lal took his grievance to the district forum at Sonepat alleging deficiency of service. The forum held that the services rendered by the ESIC were gratuitous in nature and hence not covered under CPA and dismissed the case.